Benign Tumors Flashcards by Jake Aleck

T/F: Bone islands typically do not appear “hot” on bone scans

TRUE

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are composed of
cortical bone, and appear as low
signal intensity on MRI on all
pulse sequences

bone islands

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typically appear as round-to-ovoid sclerotic intramedullary foci

bone island

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Cortical bone that has failed to undergo medullary
resorption during the process of endochondral
ossification

Bone Island: (Enostoma)

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– Located anywhere, except in skull – Discrete area of sclerosis in bone – Asymptomatic and clinically insignificant

Bone Island (BI): (Enostoma)

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distinguishes BI from blastic metastasis

Brush border

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– Age 10-25 yo – Pain relieved by Aspirin – Gradual severe deep aching pain – Pain could be referred to a nearby joint – Pain worse at night – Limited ROM, painful limp, stiffness, weakness

Osteoid Osteoma

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– Painful rigid scoliosis: usu on concave side

of curve – 50% in tibia and femur – 10% in spine affecting posterior elements

Osteoid Osteoma

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– Usu <1.0 cm in size – Radiolucent nidus with surrounding reactive
sclerosis – Nidus may calcify

osteoid osteoma

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Highly vascularized fibrous connective tissue

nidus (tumor)

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T/F: May need CT & Bone Scan for spinal lesions

TRUE

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– DDX:
• Spondylolysis
• Congenital agenesis of contralateral pedicle
• Osteoblastoma
• Blastic metastasis
• Brodie’s abscess
• Stress Fracture
• Garre’s Chronic Sclerosing Osteomyelitis

osteoid osteoma

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– DDX:

• Blastic metastasis • Osteoid osteoma • Osteoma • Osteopoikilosis

Bone Island: (Enostoma)

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• Pain is relieved by aspirin and nonsteroidal anti-
inflammatory drugs • Very high levels of prostaglandins have been found in the
lesion

Osteoid Osteoma

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– Aspirin also relieves pain – Pain worse at night – Nidus >1.0 cm in size – No angiographic vascular blush

Brodie’s Abscess

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Osteoid Osteoma tx:

NSAIDS until pain subsides

Thermocoagulation (92% case success)

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An insulated SMK C-15 electrode was inserted through
the cannula into the lesion and its position confirmed by
CT imaging

THERMOCOAGULATION

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– Peak age range 10-20 yo – Usually located in posterior neural arch of spine – Pain, that is usually not at night, and not relieved by aspirin

Osteoblastoma

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– Painful scoliosis – 2-10 cm in size – Expansile lesion with eggshell-thin cortical margin – May be sclerotic

Osteoblastoma

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T/F: Small percentage of osteoblastomas become malignant

TRUE

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shows fluid in MRI: T1 or T2

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– Arises from residual islands of cartilage left in metaphysis
as physis grows away – Hands (50%) and feet

Solitary Enchondroma

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mc location solitary enchondroma

hand

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solitary enchondroma: Sudden onset of pain without trauma signals _______

malignant transformation

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50% have punctate calcification due to | cartilagenous matrix

Solitary Enchondroma

Post trauma introduction of epidermoid tissue into bone

Inclusion cyst

Neuroarterial lesion in hand causing pressure erosion of tuft

Glomus tumor

if surgery... Replace with bone chips, or cement packing (calcium phosphate packing)

Solitary Enchondroma

Enchondroma with malignant transformation to a

Chondrosarcoma

T/F: Solitary Enchondroma is more likely malignant if hot on bone scan

TRUE

– Unossified remnants of cartilage in diaphyses and metaphyses – Not usu painful, unless pathologic fracture – Likes small bones of hands and feet – Large lesions result in bone deformities

Multiple Enchondromatosis

aka Ollier’s disease

Multiple Enchondromatosis

_____ is helpful to detect malignant degeneration of Multiple Enchondromatosis

MRI

Multiple radiolucent metaphyseal lesions of the proximal and middle phalanges of the fourth and fifth digits, and the distal metacarpals of the fourth and fifth digits

Multiple Enchondromatosis

– Enchondromatosis of bone and soft tissue cavernous hemangiomas – Rare – MC affects hands

Maffucci’s Syndrome

These hemangiomas in Maffucci's syndrome are benign and asymptomatic, however may turn _____

malignant

maffucci's: Areas of radiolucency represent enchondromas, and opaque spots represent

phleboliths

T/F: The hemangiomas may occur in other organs, including the GI tract

TRUE

The incidence of malignant transformation is higher in ____ compared to Ollier's

maffucci's

– Rare primary benign bone tumor of cartilage origin – 10-25 yo – Arises from cells of physis – Pain, and pain in nearby joint – Local tenderness and swelling

Chondroblastoma: | Codman’s tumor

Chondroblastoma located where in the bone

Epiphyseal and Apophyseal (tuberosity or trochanter)

what is bright in a T1 sequence MRI

bone marrow

– Classified as a tumor of cartilagenous origin – Rare – Composed of chondroid, fibrous, and myxoid tissues in varying proportions

Chondromyxoid Fibroma

``` – 1-10cm in diameter – Local pain with swelling – May be incidental finding – Usu Proximal Third of Tibia – Metaphyseal origin ```

Chondromyxoid Fibroma

``` – 4-8 yo – Asymptomatic – Posterior – medial surface of DISTAL FEMUR, lower extremity – Could be associated with avulsion fracture at a muscle attachment ```

Fibrous Cortical Defect

``` – 8-20 yo – Due to faulty ossification, and not a true neoplasm – Usu asymptomatic – Large lesion may be painful, >8 cm • Pathologic fracture • Stress fracture – MC distal tibia ```

Non-Ossifying Fibroma

– Lytic, eccentric, ovoid, thins and expands cortex – Multilocular appearance – 2-7 cm in length – Dense sclerotic border along medullary side – Periosteal reaction with pathologic fx – No malignant transformation

Non-Ossifying Fibroma

``` • Lobulated well-circumscribed nonossifying fibroma that is eccentrically located within the distal tibial metadiaphysis • Peripheral sclerotic border with a central lucency is typical of this lesion ```

Non-Ossifying Fibroma

– Aka unicameral (one house) _____ – Fluid filled cyst lined with thin layer of fibrous tissue – 3-14 yo – 2/3 undergo pathologic fx

simple bone cyst

– Originates in metaphysis (_____ cyst)

active

– Latent cyst in diaphysis (_____ cyst with growth potential)

latent

– Geographic or cystic radiolucency that is broad at metaphyseal end, and narrower at diaphyseal end – Truncated cone shaped appearance – Endosteal scalloping – Light, incomplete septation – No Matrix Calcification

simple bone cyst

simple bone cysts are exposed in what type of image

MRI T2 w/ fat suppression or stir/spur

``` simple bone cyst: • Small, detached, floating bone fragment • Changes position in cyst with movement ```

fallen fragment sign

simple bone cyst: If fragment is attached at one end, but opposite end moves with movement

Hinged Fragment Sign

Oval, geographic radiolucent lesion in subtalar region of anterior calcaneus

Calcaneal Cyst

``` – Cystic cavity filled with blood – Channels containing flowing blood – Not a true cyst – Not an aneurysm – Pathogenesis is not known (probably posttraumatic) ```

Aneurysmal Bone Cyst | ABC

– Likes posterior neural arch of spine, therefore see neurological changes relating to spinal stenosis – 5-20 yo – Acute pain with RAPID increasing severity of pain – Frequent pathologic fx

Aneurysmal Bone Cyst | ABC

``` – Expanding fast growing – Thinning of cortex (EGGSHELL) – Soap bubble – May cross growth plate and affect epiphysis – 8-10 cm in size ```

Aneurysmal Bone Cyst | ABC

tx of Aneurysmal Bone Cyst

– Surgical curettage packed with bone chips | – High recurrence rate

Rarest primary benign bone tumor Age 5-70 yo Usually asymptomatic Usually found incidentally mc in metaphyses of long bones, particularly tibia and fibula, calcaneus and metatarsals

Intraosseous Lipoma

* Lytic lesion with well defined or sclerotic border * May be expansile with endosteal scalloping * Calcific radiopacity of central necrosis

Intraosseous Lipoma

``` – Slow growing – Composed of newly formed capillary, cavernous, or venous blood vessels – Usually asymptomatic – MC benign bone tumor of spine ```

Hemangioma

Most symptomatic spinal hemangioma lesions are in the _______ spine since spinal canal vs. cord size is smallest

mid thoracics

T/F: Hemangioma in Maxilla and Mandible may result in death during tooth extraction due to exsanguination of blood

TRUE

– 75% of lesions are located in spine and skull – Lower thoracic and upper lumbar region – May extend into posterior neural arch 10-15% – If in skull, usually frontal bone

Hemangioma

_______ hemangiomas are most common

Cavernous

Spherical calcifications represent ______ which characterize the vascular nature of the soft tissue mass lesion

phleboliths | Soft Tissue Hemangioma

CT: Polka Dot Appearance MRI: Jailhouse Appearance, Corduroy Cloth Appearance

Hemangioma

The most commonly affected bones in the skull are the ______, and life-threatening bleeding after a simple tooth extraction is frequently observed

mandible and the maxilla

– Bony exostosis projecting from external surface of bone – Usually has hyaline lined cartilagenous cap – MC benign skeletal growth or tumor

Solitary Osteochondroma

``` – Metaphyseal – Calcified cartilagenous cap – Points AWAY from joint due to muscle pull – Coat hanger exostosis – Knee mc affected ```

Solitary Osteochondroma

– Multiple osteochondromas – 2-10 yo – 2-100’s of osteochondromas, average of 10 – Usually bilateral and symmetric – Painless lumpy joints

HME: Hereditary Multiple Exostoses

* Shortening of ulna | * Outward bowing of radius • Subluxation of radioulnar joint

Bayonet Hand Deformity | HME

T/F: Lesions (HME) within or close to axial skeleton are most likely to degenerate to malignancy

TRUE